NHS :: Prescribing Costs in Primary Care – NAO

The National Audit Office scrutinises public spending on behalf of UK Parliament. They are totally independent of Government. The NAO is headed by the Comptroller and Auditor General, Sir John Bourn. NAO recently published its report to reduce the primary care cost in the country.

The National Health Service spends ?8 billion a year on prescription drugs in primary care in England. Expenditure on primary care drugs has increased by 60 per cent in real terms over the last decade, and the number of items dispensed has increased by 55 per cent. The continued development of new drugs for use in the NHS, the identification of new applications for existing drugs, and England?s ageing population, mean that further growth can be expected.

There are, however, ways in which the Department of Health (the Department) and NHS bodies can help make growth more affordable without affecting patient care, and hence enable more people to be treated or expensive treatments to be made more widely available. They can seek to influence doctors? prescribing decisions, for example where different drugs have the same clinical effect but different prices; and they can seek to control the prices the NHS pays for drugs.

This report examines the first of these approaches: supporting doctors and other prescribers in their prescribing decisions. We looked at the scope for improving the efficiency of prescribing, issues involved in assessing prescribing effectiveness, and the influences on prescribing behaviour. We also examined the extent of drugs wastage, due, for example, to patients not taking drugs they were prescribed, or being given repeat prescriptions for medicines of which they already had a sufficient stock.

The Department?s main mechanism for controlling drugs prices is the Pharmaceutical Price Regulation Scheme, an agreement negotiated every five years with the pharmaceutical industry, that aims to ensure that the health service can obtain drugs at fair prices, whilst promoting a strong industry capable of developing new and improved medicines. This scheme has recently been the subject of a review by the Office of Fair Trading, which has made recommendations for reform of the scheme (summarised in Appendix 1), which the Government is currently considering.

There is scope to improve the efficiency of prescribing in primary care. Improving efficiency frees up money, without affecting clinical outcomes, which can then be used to pay for treatments for other patients. We found over ?200 million of potential efficiency savings by looking at just 19 per cent of the primary care drugs bill. The areas we examined offer the most significant savings opportunities, but further savings may be possible in other areas of primary care drugs expenditure.

Wastage of drugs, under-prescribing, and overprescribing, whenever they occur, represent poor value for money. The Department of Health does not currently monitor levels of drugs wastage, so it is difficult to form a view on whether its current anti-wastage measures are proportionate. Assessing whether local prescribing volumes are consistent with clinical need is complex. However, combining prescription data with local prevalence data can provide benchmark information for PCTs and GP practices to help identify opportunities for improving the value for money they get from their prescribing.